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City of Santa , _.ia <br />Clerk of the Council <br />COTC Office Use Only <br />AGREEMENT TERMINATION FORM �� I Dg <br />Please complete this form in its entirety when the attached agreement and all <br />amendments (if any) are no longer in effect. <br />Note: If your agreement is grant related, please ensure that all grant retention requirements <br />have been satisfied prior to signing the termination form. <br />Is the agreement(s) a permanent record? Yes No —/ <br />Return form to the Clerk of the Council Office (M-30). <br />Call 647-1520 if you have any questions. <br />The agreement with <br />r'aa Va etc. <br />No. A-2020-043-30 was completed on 17 z <br />(List all amendments. Use space below if needed.) <br />Department: <br />Phone/Ext.: <br />Signature: <br />Date: <br />i lagreementsbrmslform - agreement termination form_goldenrod.doc <br />OF THE COUNCIL <br />� 2'2"3 Pr,2:24 <br />and final payment has been made. <br />C914 <br />